Anne van Dalen

200 I Chapter 7 interrelationships between culture, technology, and achieving reliable, high-quality patient outcomes. Because, there are still significant challenges to provide safe patient care in the high technology environment of the OR. 28,29 Implementation of an ORBB, or other video- and medical data recorders, may improve safety behaviour by facilitating team debriefing, coaching and training. 30-32 Understanding safety behaviour is fundamental to developing the teamwork and robust communications that are essential to create a high- reliability organization focused on improving patient safety. 28,33 During (video-assisted) team debriefings, with our without the use of an ORBB, differences in safety behaviour perceptions may be discussed, emphasizing collective accountability for errors in a safe, blame-free, non-hierarchical environment. 5,34 Successful implementation of novel safety and quality improvement interventions, like an ORBB will require a collective understanding of the importance of transparency concerning safety improvement gaps, as well as a strong commitment to communication openness during both the surgical procedures and debriefings. 5,35 For a strong safety culture, all OR team members ought to be engaged and believe change in behaviour can actually improve patient safety. When implementing a video- and medical data recorder or team debriefing, it may hence be considered important to firstly assess its impact on safety needs, beliefs and perceptions of all professionals working in the OR, irrespective of experience, hours and years working in the hospital. Promoting positive safety behaviour may also help healthcare organizations to implement quality and safety improvement systems more broadly and in a sustainable manner. Future multi-centre studies, on larger scale, across settings using (different types of) medical data recorders providing output supporting team debriefing and team training are recommended. Patient related outcome data should be included to evaluate whether improved safety behaviour actually leads to a reduction of preventable errors. Also, to strengthen the degree to which suitable inferences can safely be drawn about the impact of behavioural monitoring using medical data recorders under strict and safeguarded conditions on patient safety culture and behaviour. 36